Statement of unclaimed dividends or undistributed assets, paid under section 352 (1) and (2), into the Company Liquidation Dividend and Undistributed Assets Account

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....Liquidation Dividend and Undistributed Assets Account. Name of the company Nature of the proceeding* Date of commencement of winding up Date of payment into the Company Liquidation Dividend and Undistributed Assets Account I. Particulars of the unclaimed dividends paid into the Companies Liquidation Dividend and Undistributed Assets Account in the Scheduled Bank. Number on list of creditors ....